A28 RFQ.pdf
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15DDHQ21Q00000172 Page 1 of 9
Section 2 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0001 *NON-RETURNABLE* GLOVES, KC500 PURPLE NITRILE, LG
LATEX FREE, POWDER FREE, 9.5 IN CUFF 100/BX 10BX/C
1 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0002 NITROSTAT TABS SL 0.4MG 100/BT 1 BT $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0003 BANDAGE ELASTIC LATEX FREE 4 IN 10RLS/BX 40 RL $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0004 GAUZE SPONGS, DERMACEA, STERILE 12 PLY 4 IN X
4 IN 2/PK 25PK/BX 24BX/CS
6 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0005 DUCT TAPE KIT 100 IN X 2 IN W 1/EA 500EA/CS 40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0006 BANDAGE, ADHESIVE, AMERICAN WHITE CROSS, 3/4 IN
3 IN, FABRIC FLEXIBLE 100/BX, 12BX/CS
4 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0007 CURAPLEX TRIANGLE BANDAGE, MUSLIN 12/PK
20PK/CS 40 IN X 40 IN X 56 IN
8 PG $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0008 QUIK CLOT COMBAT GAUZE, LE Z-FOLD, 3 INCH X 4 YARD
BLACK PACKAGING 50EA/CS
16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0009 HALO VENT 2PK 200PK/CS (1 VENTED AND 1 NON VENTED
IN PK)
16 PG $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0010 OINTMENT, HYDROCORTISONE, 1%, 1/32 OZ PACKET
144/BX 12BX/CS
1 BX $________ $_________________
15DDHQ21Q00000172 Page 2 of 9
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0011 MEDIQUE APAP, ACETAMINOPHEN 325MG TABLETS, 2/PK
75PK/BX 24BX/CS
3 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0012 Z-FOLDED DRESSING OLIVE DRAB 144/CS VACUUM
SEALED
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0013 *NON-RETURNABLE* HAND WIPES ANTIMICROBIAL
INDIVIDUALLY WRAPPED FRESH SCENT 100/BX
10BX/CS PAWS 34400
2 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0014 TOURNIQUET, SAM XT EXTREMITY TOURNIQUET, BY
CURAPLEX BLACK
8 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0015 CALAMINE LOTION 6 OZ. BOTTLE 8 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0016 *NON-RETURNABLE* GLOVES, KC500 PURPLE NITRILE, LG
LATEX FREE, POWDER FREE, 9.5 IN CUFF 100/BX 10BX/C
1 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0017 SPLINT, SAM, EXTRA WIDE, 5.5 IN X 36 IN, FLATFOLD
ORANGE 60EA/CS
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0018 DIPHENHYDRAMINE 25MG CAP UD 100/BX 1 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0019 CPR BARRIER, CPR MICROSHIELD-XL, ORANGE CASE,
7 IN X 6 3/4 IN 50EA/CS
16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0020 BACITRACIN ZINC FOILPAC 0.9GM 144/BX 9908
128X/CS
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT
15DDHQ21Q00000172 Page 3 of 9
UNIT PRICE AMOUNT
0021 IV SOLUTION, SODIUM CHLORIDE 0.9% 500ML BAG 24EA/CS
BAXTER 2B1323Q
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0022 POVIDONE IODINE (PVP) PREP PADS 100/BX 10BX/CS 1 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0023 RESCUE BLANKET, ALUMINIZED, 56 IN X 84 IN, TRAPS
80% OF BODY HEAT TO COMBAT SHOCK AND
HYPOTHERMIA
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0024 PAIN RELIEVER ASPRIN 325MG 2/PK 50PK/BX
15BX/CS
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0025 GLUCOSE TUBE UNIT DOES 400/CS GLUTOSE-15
0069-15
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0026 ARS FOR NEEDLE DECOMPRESSION, 14 GA X 3.25 IN,
W/PROTECTIVE CASE, ORANGE BAND/HUB
16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0027 POCKET BVM, BLACK CASE, HAND HELD, DISPOSABLE,
FOR MANUAL RESUSCITATION OF ADULT PATIENTS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0028 BANDDAGE ADHESIVE PLASTIC L 2 IN X 4 1/2 IN
50/BX 24BX/CS
3 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0029 UNDERPAD 17 IN X 24 IN 300/CS 40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0030 TRAUMA SHEAR BLACK 7 1/4 IN 16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0031 NASOPHARYNGEAL AIRWAY LATEX ADJUSTABLE
FLANGE 28 FRENCH 10/BX
24 EA $________ $_________________
15DDHQ21Q00000172 Page 4 of 9
0032 NASOPHARYNGEAL AIRWAY LATEX ADJUSTABLE
FLANGE 30 FRENCH 10/BX
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0033 TAPE ADHESIVE CLOTH 1 IN X 10 YARDS 12/BX
12BX/CS
2 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0034 TAPE ADHESIVE CLOTH 3 IN X 10 YARDS 4/BX
12BX/CS
2 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0035 BANDAGE ELASTIC LATEX FREE 2 IN 50RLS/CS 32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0036 EYE SHIELD METAL 12/BX FOX 16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0037 GAUZE SPONGE, DERMACEA, STERILE 8 PLY 2 IN X 2 IN
2/PK 50PK/BX 30 BX/CS 7770
4 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0038 GAUZE SPONGE, DERMACEA, STERILE 12 PLY 3 IN X 3 IN
2/PK 25PK/BX 48BX/CS
4 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0039 CURAPLEX IV ADMIN ST, 10 DRP, 83IN, PRE-PRCD Y-SITE
SRLK NDLE-FREE Y ST, ROTAT MALE LL 1/EA 50EA/CS
40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0040 MFG B/O CURAPLEX ALCOHOL PREP PAD, MEDIUM,
STERILE 200/BX 20BX/CS
2 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0041 ABDOMINAL BANDAGE, 8 IN WIDE WITH 12 IN X 12 IN XL
PAD, GREEN 50 EA/CS
8 EA $________ $_________________
0042 LUBRICATING JELLY, MEDICHOICE, STERILE, 5 GM
PACKET, 1/EA 600EA/CS
32 EA
15DDHQ21Q00000172 Page 5 of 9
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0043 LTD QTY - EYE WASH, 1 OZ BOTTLE 24EA/CS 16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0044 BUM DRESSING, FACIAL, WATER-JEL 12 INCH X 16 INCH 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0045 *NON-RETURNABLE* THERMOMETER DIGITAL
HYPOTHERMIA F/C ADTEMP 419
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0046 SPHYGMOMANOMETER ECONOMY GRAY COTTON
CUFF SIZE 11 ADULT 20/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0047 COMBAT APPLICATION TOURNIQUET (CAT) TACTICAL
BLACK, GEN 7, ONE-HANDED TOURNIQUET - WINDLASS
SYSTEM
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0048 KING LTS-D SUPRAGLOTTIC AIRWAY KIT SIZE 4 RED
1/EA 5EA/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0049 KING LTS-D SUPRAGLOTTIC AIRWAY KIT SIZE 5 PURPLE
1/EA 5EA/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0050 BANDAGE, ADHESIVE, FLEXIBLE FABRIC, KNUCLE, 1 1/2 X
3, STERILE 100/BX 24BX/CS
3 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0051 CURAPLEX OXYGEN NASAL CANNULA, ADULT,
CONVENTIONAL, GREEN, 7 FT TUBING 50EA/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0052 CURAPLEX BURN SHEET, 60 INCH X 90 INCH, STERILE
50EA/CS
8 EA $________ $_________________
15DDHQ21Q00000172 Page 6 of 9
Line Period of Performance: 08/30/2021 - 09/30/2021
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0053 READY-HEAT II 6-PANEL TORSO-SIZE BLANKET, FIRST
RESPONDER, 34 IN X 24 IN, 8-HOUR, DISPOSABLE
12EA/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0054 CURAPLEX DISPOSABLE PENLIGHT 6/PK 60PK/CS 3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0055 IV CATHETER, INSYTE AUTOGUARD, 18 GA X 1.16 IN,
SHIELDED, VIALON 50EA/BX 4BX/CS
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0056 IV CATHETER, INSYTE AUTOGUARD, 20 GA X 1.16 IN,
NOTCH NEEDLE, SHIELDED, VIALON 50EA/BX 4BX/CS
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0057 LUER ACTIVATED VALUE WITH MALE LUER LOCK
ADAPTER 200/CS CLEARLINK STERILE, NON DEHP,
NON PVC
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0058 KIT, BASIC FIELD ENT 10EA/CS 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0059 MASK TOTAL NON-REBREATHER ADULT 50/CS 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0060 ADSCOPE-LITE 619, ROYAL BLUE 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0061 SUCTION EASY DISPOSABLE SUCTION UNIT W/ ADAPTER 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0062 IV FLUSH SYRINGE, NORMAL SALINE, 10ML, PREFILLED
12CC SYRINGE, STERILE 100EA/BX 4BX/CS
32 EA $________ $_________________
0063 STERILE WATER FOR IRRIGATION, 500ML PLASTIC POUR
BOTTLE 18EA/CS
8 EA
15DDHQ21Q00000172 Page 7 of 9
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0064 CURAPLEX, SHARPS SOLO, SHARPS CONTAINER WITH ONE
TIME LOCKABLE SEAL, 6.5 IN 24EA/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0065 LITTER, TAC MED POLELESS 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0066 CURAPLEX IV START KIT W/TEGADERM, ALCOHOL PREP
2X2 SPONGE, 1 IN CLEAR TAPE, LF TOURNIQUET 1 EA
50EA/CS
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0067 ASSURE PRISM BLACK KIT ADVANCED INCI METER, BLACK
CASE, 2 BT TEST STRIPS, L1/L2 CONTROL SOLUTION
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0068 NASAL DECONGESTANT 0.05% 30ML 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0069 ROBAFEN 100MG/5ML SYRUP 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0070 CURAPLEX FINGERTIP PULSE OXIMETER 1/EA 100EA/CS 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0071 BANDAGE, COHESIVE, COBAN, TAN, 4 IN X 5 YD FULLY
STRETCHED, LATEX FREE, NON-STERILE, 18/BX
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0072 PAIN RELIEVER IBUPROFEN 200MG TABLETS 2/PK
50PK/BX 12BX/CS CEDAPRIN
4 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0073 BANDAGE EMERGENCY OLIVE DRAB 6 IN 100/CS
ISRAELI BANDAGE
16 BX $________ $_________________
15DDHQ21Q00000172 Page 8 of 9
UNIT PRICE AMOUNT
0074 BANDAGE EMERGENCY OLIVE DRAB 4 IN 100/CS
ISRAELI BANDAGE
16 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0075 EXTRICATION COLLAR, STIFNECK SELECT, ADULT,
ADJUSTABLE, NASAL CANNULA HOOK
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0076 CURAPLEX SELCT CPR POCKET MASK, O2 INLET 1/EA 100EA/
CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0077 SAM PELVIC SLING II - STANDARD 32-50 IN HIP 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0078 MEDI-FIRST SINUS DECONGESTANT PSEUDOEPHEDRINE -
FREE SINUS RELIEF 1/PK 250PK/BX 12BX/CS
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0079 TUMS ASSORTED 160/BT 2 BT $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0080 ANTACID TABLETS 48/BX 24X/CS PEPTO BISMOL 4 BX $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0081 CYLINDER OXYGEN WITH TOGGLE ALUMINUM D SIZE 8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0082 CURAPLEX OXYGEN REGULATOR, ALL-BRASS, 2 DISS, 1
BARB, CGA870
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0083 ADRENALIN (EPINEPHRINE) 1MG, 1ML (1:1000) VIAL 25EA/PK 1 PG $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0084 SYRINGE AND NEEDLE, 3CC, 22GA X 1 1/2 INCH 100/BX
10BX/CS
15DDHQ21Q00000172 Page 9 of 9
UNIT PRICE AMOUNT
0085 HYPODERMIC NEDDLE, REGULAR BEVEL, 18 GA X 1 IN,
STERILE 100/BX 20BX/CS
1 BX $________ $_________________
0086 *NON-RETURNABLE* GLOVES, KC500 PURPLE NITRILE, XL 1 BX $________ $_________________
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